Physiotherapy

In physiotherapy, exercises are performed together with the patients to improve the stability of the ankle joint. The therapy is always structured in such a way that the exercises begin simply and become increasingly difficult and can sometimes be supplemented by additional treatments. For example, the therapist can apply slight resistance to the patient’s foot or trunk while the patient has to stabilize his position.

If muscular imbalances exist, shortened muscles are stretched in physiotherapy and too weak muscles are trained. Since our large superficial calf muscles tend to shorten, and can thus promote inward twisting, this muscle group is usually stretched in a targeted manner. A running analysis and treadmill training can also be part of the physiotherapy for ankle instability.

Here one can observe whether the patient has a wrong running style, which ensures that the ankle joint is permanently at risk when running and thus causes the problems. In such a case one would have to optimize the running style. Dynamic stability is particularly difficult, for example, when absorbing a jump.

So at the end of the treatment, when all other exercises have been mastered safely, jumping and catching can be practiced on a therapy trampoline, for example, in the physiotherapeutic treatment of an ankle joint instability. It is important that no pain occurs during the exercises, as this can indicate overloading of the ligaments. After acute injuries, the therapy is usually completed after about 3 months. This can vary in the case of chronic instability. If the physiotherapeutic measures do not help, it is advisable to consider an operation.

When does surgery have to be performed?

Surgical intervention should be considered if permanent pain under stress or at rest restricts everyday mobility or if there is increased ankle twisting with subsequent slight inflammation of the joint. A stabilizing operation should minimize overloading of cartilage and bone and thus prevent arthrosis. Incarcerated structures can be removed arthroscopically.

In this case the operation is minimally invasive and can usually be treated through a small incision. In the case of tendon plastic surgery or a tendon lift, the joint is usually operated on openly. The joint mechanics and stability are restored.

If necessary, ligaments can be replaced by the body’s own tendons. It is important to maintain joint mobility despite the tightening. The joint is then immobilized with a cast or splint for 4-6 weeks, followed by intensive physiotherapeutic follow-up treatment. Before sport and training can be resumed, a doctor should confirm that mobility and coordination have been sufficiently restored to prevent the ankle joint from being put under too much stress again too soon.